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Navy S Marine Corps Medical News 


June 16, 2000 

The Navy Bureau of Medicine and Surgery distributes Navy and 
Marine Corps Medical News (MEDNEWS) to Sailors and Marines, 
their families, civilian employees and retired Navy and Marine 
Corps families . 

MEDNEWS is a weekly compendium of news and information 
contributed by commands throughout the Navy Medical department. 
Information contained in MEDNEWS stories is not necessarily 
endorsed by BUMED, nor should it be considered official Navy 

To achieve maximum medical information distribution, your 
command is highly encouraged to distribute MEDNEWS to ALL HANDS 
electronically, include MEDNEWS in command newspapers, 
newsletters and radio and TV news programs. 

Stories in MEDNEWS use these abbreviations after a Navy 
medical professional ' s name to show affiliation: MC — Medical 
Corps (physician) ; DC - Dental Corps; NC - Nurse Corps; MSC - 
Medical Service Corps (clinicians, researchers and 
administrative managers) . Hospital Corpsmen (HM) and Dental 
Technician (DT) designators are placed in front of their names. 


Contents for this week's MEDNEWS: 

Headline: Rota supports space shuttle mission 

Headline: Alcohol abuse costs DoD dearly 

Headline: Jacksonville graduates family practice residents 
Headline: Key West provides environmentally friendly care 
Headline: Consumer Reports rates TRICARE Senior Prime a top value 
Headline: Anthrax question and answer 
Headline : TRICARE question and answer 

Headline: Healthwatch: Less smoking improves troops' health, cuts 
healthcare costs 


Headline: Rota supports space shuttle mission 
By Lt.j.g. Bill Davis, Naval Station Rota 

"Houston, we have liftoff ...of the Space Shuttle Atlantis . " 
It's these words that once again recently propelled the U.S. 
space program into yet another chapter. 

The launch of Mission STS-101 with six U.S. astronauts and 
one Russian cosmonaut was completed 10 days later after the crew 
provided the International Space Station with new supplies, 
including needed batteries and a new antenna system. 

But what if something goes wrong during the launch? Who can 
forget the explosion of the Challenger less than two minutes 

after liftoff in January 1986. With each shuttle launch, what 
if something goes wrong, like an engine failure just after 
takeoff? What does the National Aeronautics and Space 
Administration (NASA) do when there is a problem? 

There are hosts of people standing by ready to assist, 
including the medical staff from U.S. Naval Hospital, Rota, 
Spain. It's the medical team's job to standby for each flight 
and be prepared to provide medical assistance to the astronauts 
in case of an aborted flight at Moron Air Base, about 80 miles 
from Rota, which is one of four trans— Atlantic abort landing 
(TAL) sites in the world. 

Lt . Cmdr. Lynn Flowers, director of the Space Shuttle Support 
Team from Rota, says it's a great opportunity for the hospital 
to work with NASA and really be a part of history with the space 
shuttle missions . It 's medical support that could potentially 
be critical to the astronaut 's lives in the case of an aborted 

"NASA establishes certain criteria for us, " Flowers said. 
"All the corpsmen have to be emergency medical technician 
certified, and the astronauts require one emergency medical 
technician each, along with one trauma trained physician for 
four astronauts . " Two nurses also accompany the medical team, 
although not required by NASA, but it ' s a service the hospital 
provides as well . 

The procedures are similar to what the nearly 20-person 
medical team goes through when they perform a mass casualty 
drill or trauma assessment. But they say it's a bit more 

"It makes me feel very good to be involved in this type of 
event, " said Hospital Corpsman Phonthip Manivanh, an emergency 
medical technician whose primary job would be to assess an 
astronaut ' s condition once cleared through decontamination . 
Medical Drill 

During a scheduled launch in late April, the U.S. Naval 
Hospital Rota medical team prepared a mock trauma scene to 
simulate a real disaster in case of a landing at Moron and there 
were injuries. The training looks good on paper, but according 
to Flowers, it 's not until you actually conduct it that you can 
work out any bugs in the system, or be able to see any areas 
that need improvement . 

About four hours before the launch on April 24, which was the 
first attempted launch that was scrubbed, the medical team 

'treated' the injured in a simulated drill just as though it 
were the real thing. Hospital Corpsman 2nd Class Yvette Yeager, 
whose normal job at the hospital is in the surgery clinic, said, 

"The training builds our confidence level, as well as our skills 
and knowledge to do things faster and better. " She is one of 
the seven EMTs on the team. 

Hospital Corpsman 3rd Class Thaddeus Estacio joined the Navy 
five years ago and sees his role in this real— world mission as a 

"big thing and nice experience. " Estacio ' s patient in the drill 
had a lump in his neck, weakness in his arms, and no sensation 
from the waist down. "Possible spinal injury..ISed Code One, " he 

Medical staff observed the mock trauma drill to evaluate weak 
and strong spots and to be ready for the unexpected. 

"Overall, the crew did a great job, " said Lt . Rebecca Carlin, 
U.S. Naval Hospital Rota flight surgeon and observer for the 

"I feel very comfortable that if the shuttle did come and 
land here, the training that we do regularly would enable this 
team to do an outstanding job, " said Flowers. 

While no space shuttle flight has ever had to use one of the 
TAL sites, having these locations available for a contingency is 
crucial to the launch, says Lt. Cmdr. Alan Poindexter, an 
astronaut with NASA. He says the sites like Moron are similar 
to an insurance policy. It's there in case you need it. 

Poindexter said that if there is a problem in the first few 
minutes of the flight, the shuttle could go back to Kennedy 
Space Center at Cape Canaveral, Florida, where it was launched. 
But as the launch progresses, from about four minutes to eight 
minutes, he says aborting the mission could mean landing at one 
of the TAL sites. By the eight-minute mark, the shuttle has 
accelerated to about 17,000 miles per hour. The thrust of the 
shuttle engines is more powerful than 35 jumbo jets at takeoff, 
and timing is of great concern. 

In the case of engine failure during the four-minute span, 
sites such as Moron would come into play with the Rota medical 
team standing by to provide any treatment to the astronauts . 
The runway at Moron is fully lit just like the runway at Kennedy 
Space Center. Poindexter says the process from mission abort to 
landing at Moron would take about 30 minutes. 

Once on the ground at Moron, a crew from the base, consisting 
of Americans and Spanish, would ensure the shuttle is free of 
anything toxic. After the shuttle is cleared, the astronauts 
would clear decontamination and then be examined by the medical 

Working as a team is the primary goal of Lt. Col. J. C. 
Crownover, 496th Air Base Squadron Commander at Moron. While 
Americans and Spanish from the base are working the shuttle 
recovery, it's the support from U.S. Naval Hospital Rota that's 
vital, he said. "It couldn't be a contingency site without the 
medical support from Rota. " 

The training by the medical team gave the U.S. Naval Hospital 
Rota staff the experience and confidence they need in order to 
do their job in a professional manner. It's a role that should 
be increasing, according to Poindexter. "Once we have the space 
station with a continuous presence (as early as this Fall), 
there may be up to six or eight flights a year. " The next 
shuttle launch is scheduled for later this summer. 

The U.S. Naval Hospital Rota staff says they will be 
ready...ready for the unexpected, just in case the shuttle has to 
abort the mission and land at Moron. It's a job they train for, 
and as Estacio says, it 's a job they need to do fast and do 
well. "Lives are at stake. " 


Headline: Alcohol abuse costs DoD dearly 

By Staff Sgt . Kathleen T. Rhem, USA, American Forces Press 


WASHINGTON — Twenty— one percent of service members admit to 
drinking heavily — a statistic the military hasn't managed to 
lower in 20 years — but service officials are determined to 
change that . 

"If you look at heavy use of alcohol, drinking a lot in a 
short span of time, we tend to have a higher prevalence than the 
civilian community," said Lt. Col. Wayne Talcott, 

an Air Force psychologist . Young military people between 18 and 
25 also tend to do more heavy drinking than their civilian 
peers, he noted. 

Speaking only in terms of medical care and lost time at work, 
alcohol abuse costs DoD more than $600 million each year, said 
Navy Capt. Robert Murphy, a medical corps officer. DoD spends 
another $132 million a year to care for babies with fetal 
alcohol syndrome — sometimes— serious health problems related to 
their mothers ' heavy drinking. 

Talcott and Murphy co-chair the relatively new DoD Alcohol 
Abuse and Tobacco Use Reduction Committee. Their goal is to 
reduce the prevalence of heavy drinking within the military by 5 
percent a year by changing DoD officials ' focus on alcohol abuse 
from treatment to prevention. 

"We have very good treatment programs, but they're very 
expensive and don't reach enough people, " Murphy said. "We're 
focusing on prevention. We're certainly not opposed to alcohol 
use, but we are trying to reduce the prevalence of alcohol 
abuse. " 

"We're trying to prevent people from having to see a 
specialist , " Talcott said. "If you want to decrease prevalence, 
you need to have policies and programs in place across the 
spectrum to discourage heavy drinking. " 

As some colleges do with their students, Talcott said, the 
committee wants to help service members understand the 
liabilities associated with heavy drinking. "We want to help 
them understand if you drink this much and you drive you 're 
going to be under the influence, or at this level you 're 
impaired, " he said. 

The committee also aims to better track alcohol-related 
adverse events, such as incidences of driving under the 
influence, suicides, crimes and domestic violence. Murphy said. 
He explained there ' s no centralized DoD tracking system, though 
the services collect data that can be collated into DoD-wide 

Recent civilian studies have turned up some frightening 
statistics. Murphy said. Thirty-one percent of all occupational 
injuries are alcohol-related, as are 23 percent of suicides and 
32 percent of homicides . 

Talcott said senior officials have likened DoD's new approach 
to preventive maintenance. "You maintain a jet engine so it 
doesn't fall out of the sky, " he said. "We need to begin to 
look at where there are risks to the human weapon system and how 
we can build a system that protects our people. " 

This is very different from previous approaches, he said. 

"you typically have program offices that largely are designed to 
treat people with alcohol problems, " Talcott 

explained. "Rather than waiting for people to develop severe 
problems, we want to build into the system ways to get the right 
messages to help our people make better decisions about their 
drinking behavior . 

"It 's not the use, it 's alcohol abuse that gets people into 
trouble, " he said. 


Headline : Jacksonville graduates family practice residents 
By Carol Honsinger, Naval Hospital Jacksonville 

JACKSONVILLE, Fla. — Naval Hospital Jacksonville will hold a 
graduation ceremony Friday, June 30 for 25 Navy physicians who 
have successfully completed residency training in the specialty 
of Family Practice . 

The graduation ceremony will be held at the River View 
Officer's Club, Naval Air Station Jacksonville at 10 a.m. Vice 
Admiral Richard A. Nelson, MC, Navy Surgeon General will be 
guest speaker. 

Twelve physicians will receive Residency Certificates from 
the American Academy of Family Physicians and the Bureau of 
Medicine and Surgery for completing the 36-month residency- 
training program. Thirteen physicians will receive Certificates 
of Internship in Family Practice from the Bureau of Medicine and 
Surgery for completing their first year of the program. They 
will be providing care to active duty personnel and their family 
members in remote locations such as Bahrain, Iceland and other 
locations throughout the Navy. 

Naval Hospital Jacksonville has a long tradition in the 
training of primary care physicians . In 1963, the hospital was 
one of the first in the country to offer a General Practice 
Residency Training Program. The hospital offered a unique blend 
of individual teaching and direct patient care for those 
residents in general practice. 

In 1969, with the emergence of the Family Practice movement, 
the General Practice Program was completely reorganized in 
philosophy and curriculum. Out of this reorganization came a 
Family Practice Residency Program which was one of the first 
approved in the country. During that time, the program had 24 
Family Practice Residents and has since grown to 39 resident 
positions . 

The three-year accredited program is the only residency at 
Naval Hospital Jacksonville. Educational experience includes 
rotations in Internal Medicine, Emergency Medicine, Pediatrics, 
OB/GYN, Surgery, Orthopedics, Dermatology, Urology, Family 
Medicine, Ophthalmology, ENT, Geriatrics, Cardiology, Medical 
Intensive Care, Neonatal Intensive Care, Psychiatry, Neurology, 
Community Medicine, Radiology, and a variety of sub-specialty 
electives. Successful completion of the residency is required 
for a physician to sit for American Board of Family Practice 
certification . 

First year residents may be selected to continue straight 
through with residency or may receive orders to the fleet as 

General Medical Officers. Some choose a course of instruction 
leading to Flight Surgeon or Undersea Medicine Designation. 
Following operational assignments of 2 or more years, many 
return to residency to complete the 2nd and 3rd years. The 
physicians expand their knowledge base and learn to care for 
more complicated medical conditions as they progress through 
training. Family Physicians are capable of managing the 
majority of most patients ' medical problems from infancy through 

Completing the three-year Family Practice Training Program is 
a significant professional milestone for these physicians, but 
the real winners are the Navy and Marine Corps families who will 
receive their health care from a Naval Family Physician. 


Headline: Key West provides environmentally friendly care 
By Lt. Cmdr. DeAnn Farr, MSC, Branch Medical Clinic Key West 

KEY WEST, Fla. - Branch Medical Clinic Key West is showing 
how it can be environmentally friendly and still provide quality 
and timely imaging services to its customers. 

When the medical team moved into its new facility a few 
months ago, new gear waiting for them included digital x-ray 
equipment. There was not only new equipment, but a hospital 
corpsman to operate it who was registered with the American 
Registry of Radiological Technologists, and who is also a member 
of the American Society of Radiologic Technologists . 

Hospital Corpsman 2nd Class Mike Latimer has the latest 
training and credentials to provide both quality and timely 
service using the digital imaging devices. 

"We not only don't use film and chemicals anymore, " said 
Latimer, "but we also don 't have to worry about whether a doctor 
is available here to interpret the x-rays. Our new system 
allows us to transmit the images to Naval Hospital Jacksonville 
to be evaluated by a doctor there, who then provides us with 
diagnosis information . " 

The combination of environmental concern and a well— trained 
operator is a win for Navy medicine being a good neighbor, and 
customers receive care from a well— trained staff. 

Latimer attended an American Society of Radiologic 
Technologists (ASRT) Conference June 3—8 in Albuquerque, N.M. 
His attendance was to gain new information and to also 
participate by serving in the conference's House of Delegates. 

"Participating as a delegate allowed me to bring back 
information about how the organization 's decisions will affect 
our profession, " said Latimer. "I also learned the latest 
techniques for using our digital imaging equipment, and I 
learned procedures for improving patient care within our 
department . " 

The 234-member House of Delegates is ASRT's governing body. 
Delegates, who are elected by the membership, meet annually to 
debate issues and set direction for the profession. ASRT 
members work in the fields of radiography, nuclear medicine, 
magnetic resonance, radiation therapy, medical dosimerty, 
mammography, sonography and other specialty areas. 

"Having this digital imaging equipment means better service 
for our customers, and it also means less impact on the 
environment, " said Latimer. "Key West is an extremely 
environmentally sensitive area so our branch medical clinic 
tries to help wherever we can. " 


Headline: Consumer Reports rates TRICARE Senior Prime a top 

From TRICARE Management Activity 

WASHINGTON — TRICARE Senior Prime (TSP) , the Department of 
Defense ' s (DoD) demonstration version of a Medicare health 
maintenance organization (HMO), has been rated by Consumer 
Reports at the top of its list in value in two cities where it 
is offered . 

The June issue of the magazine rated the value of Medicare 
HMOs in 30 cities, including Seattle and Denver, where two of 
the DoD's six TSP demonstration sites are located. The rating 
was based on Health Care Financing Administration data on 
benefits, premiums, satisfaction data, and other criteria. 
Health Care Financing Administration is the agency that 
administers Medicare. 

The Robert Wood Johnson Foundation and The Commonwealth Fund, 
philanthropic organizations interested in health care, funded 
the evaluations of the Medicare HMOs for Consumer Reports . 

"In both cities, TRICARE Senior Prime was clearly the top 
plan for value — easily beating any competitor, " said Dr. H. 
James T. Sears, executive director, TRICARE Management Activity , 
which is responsible for oversight of the TSP program. "This is 
further evidence of the high quality of the TRICARE Prime 
benefit that the DoD offers to all its eligible beneficiaries. 
In combination with Medicare in this special demonstration 
program, it is a superior health care benefit." 

To participate in a Medicare HMO, beneficiaries must be 
enrolled in Part B of Medicare. Some of the rated Medicare HMOs 
charge annual premiums that range from $240 to $1,068, and many 
offer no prescription coverage. TRICARE Senior Prime enrollees 
pay no premium or enrollment fees, and it offers prescription 
coverage that Consumer Reports rated "excellent" in both cities. 
Only one other plan received an "excellent" prescription rating. 
A plan with an "excellent" rating has essentially unlimited 
benefits, covering more than 75 percent of average drug costs. 

Consumer Reports used a "value index" that compared the value 
of significant benefits for each plan with the value of Medicare 
benefits plus the premium. A value index greater than 100 
indicates you are getting a lot of value for your money, and one 
less than 100 means you are getting less. TRICARE Senior Prime 
received a rating of approximately 127 in both Seattle and 
Denver . 

TRICARE Senior Prime is one of several demonstration programs 
designed by the DoD to provide expanded health care services to 
beneficiaries, age 65 and over, of the uniformed services. 

It provides enrollees with all the benefits available under 
Medicare, plus the additional benefits of TRICARE Prime that are 

available to eligible beneficiaries under age 65. With TSP, 
retirees, dependents and survivors age 65 and over have expanded 
access to health care; preventive care; the DoD's National Mail 
Order Pharmacy; a primary care manager; reduced out-of-pocket 
costs; care from a provider network; TRICARE's 24-hour Health 
Care Information Line, and 24— hour assistance from health care 
finders in arranging appointments. 

To enroll in TSP, beneficiaries must live in the service area 
of a participating military treatment facility, and they must 
agree to obtain covered services only through TSP. 

Fort Carson and the Air Force Academy hospitals in Colorado 
Springs, Colo., and Madigan Army Medical Center in Fort Lewis, 
Wash., serve TSP enrollees in the Denver and Seattle areas. The 
Colorado Springs catchment area extends into Denver. Other TSP 
demonstrations sites, which are located in areas not rated by 
Consumer Reports, include Keesler Air Force Base, Biloxi, Miss., 
Wilford Hall Air Force Medical Center and Brooke Army Medical 
Center in San Antonio, Texas (including satellite sites at 
Sheppard Air Force Base in Wichita Falls, Texas, and Fort Sill 
in Lawton, Okla.), Naval Medical Center San Diego in San Diego, 
Calif. , and Dover Air Force Base Hospital in Dover, Del . For 
more information about TRICARE Senior Prime, visit the Military 
Health System/ TRICARE Web site at or 
contact the TRICARE contractor in a region with a demonstration 
site. Details about the Consumer Reports article can be found 
on the Internet at 

http: //www. consumerreports . org/Special/Free/Reports/0006med65 . ht 


Headline: Anthrax question and answer 
From Bureau of Medicine and Surgery 
Question: What is anthrax? 

Answer: Anthrax is a rapidly progressing acute infection 
caused by spore-forming bacteria called Bacillus anthracis . 
Anthrax most commonly occurs in warm— blooded animals, especially 
goats, cattle, and sheep, but it can also infect humans. 
Anthrax spores can be easily produced in a dry form for 
biological weapons. Spores can survive many years in adverse 
conditions and still remain capable of causing disease . When 
inhaled by humans, these spores cause respiratory failure, 
leading to death within a week. 

Anthrax can make an excellent weapon of mass destruction. The 
spores may be used as a weapon in a variety of delivery systems. 
They can be produced in large quantities without sophisticated 
equipment . All it takes is a single breath of aerosolized 
anthrax to inhale enough spores to cause the disease. Then, if 
serious symptoms occur, it kills 99 percent of unprotected 
people. Even if a person with symptoms receives antibiotics, 
the death rate is still about 80 percent . Anthrax spores are 
odorless, colorless and tasteless. 

For more information visit the Navy medical anthrax website 
at http: //www— or the DOD 
anthrax website at 


Headline: TRICARE question and answer 
From Bureau of Medicine and Surgery 

Question: If I am already confident that I need to see a 
specialist, do I need to contact my PCM before I go? What will 
happen if I don't? 

Answer: For those enrolled in TRICARE Prime, it is always 
necessary to first consult your Primary Care Manager for 
specialty care. If it is necessary for you to see a specialist, 
your PCM will help make an appointment for you. If you see a 
specialist on your own, without prior approval from your PCM you 
will be participating in Prime's Point— of-Service option and 
will be responsible for 50 percent of the cost after the 
deductible ($300 for single enrollment and $600 for family 
enrollment ) is met . 

For more information about TRICARE, visit its website at 
http: //www. tricare . or contact your health benefits 
adviser in your local TRICARE region. 


Headline: Healthwatch: Less smoking improves troops' health, 
cuts healthcare costs 

By Staff Sgt . Kathleen T. Rhem, USA, American Forces Press 

WASHINGTON — Tobacco use in DoD has dropped significantly in 
the last two decades, generally mirroring civilian rates. But 
30 percent of the active duty force still smokes. 

"Since 1995 there hasn't been much change in that 
percentage, " said Lt. Col. Wayne Talcott, an Air Force 
psychologist who is co-chairman of the DoD Alcohol Abuse and 
Tobacco Use Reduction Committee. "We'd like to see a continued 
downward trend. " 

He said DoD hopes to meet the U.S. Department of Health and 
Human Services ' Healthy People 2010 goal of a 12 percent smoker 
rate. DoD spends $930 million per year on healthcare for 
smoking— related illnesses and lost productivity in DoD 
beneficiaries, Talcott said. 

A recent study of just active duty Air Force members below 
age 36 shows that service spends $107 million a year to treat 
smokers and for lost time due to smoke breaks. The study 
assumed "a conservative estimate" of three 10-minute smoke 
breaks a day. 

"If you look at that in man-hour equivalents , that 's how much 
it would cost to employ 3,537 people for a year, about the 
number on an average-sized Air Force base, " Talcott said. 

All four services prohibit smoking throughout basic training, 
and Talcott believes that makes it an ideal time to quit for 

"There are certain times people are more willing to make 
changes. For instance, women are more likely to quit smoking 
when they become pregnant, " he said. "We believed basic 
training is another one of those times — people have already 
said they'd wear different clothes, march in a line and do 
things they've never done before. " 

They are much more open to change. To test this theory, the 

National Institutes of Health in Bethesda, Md. , granted the 
University of Memphis $3 million in the mid-1990s to survey the 
smoking habits of all 35, 000 Air Force recruits in a year. 

All the trainees received a one-hour class on the benefits 
not smoking. A year after basic, researchers polled 95 percent 
of the pre— training smokers and 65 percent of the pre— training 
nonsmokers . Findings were mixed. Officials learned that 17.7 
percent of the smokers had quit for good. Unfortunately, 
Talcott said, 11 percent of the nonsmokers picked up the habit. 
"So we still have some work to do, " he said. 

Talcott also said the committee, which is less than a year 
old, plans to take steps through both policy and programs to 
attempt to decrease the number of smokers in the DoD. Tobacco 
use is the single most preventable cause of premature death in 
the United States, he said. "That makes it a worthy thing for 
us to study. " 


Comments about and ideas for MEDNEWS are welcome. Story 
submissions are encouraged. Contact MEDNEWS editor. Earl W. 
Hicks, at email:; Telephone 202/762- 
3223, (DSN) 762-3223, or fax 202/762-3224.